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expert reaction to observational study looking mental health outcomes after COVID-19 infection

An observational study published in The BMJ looks at risks of mental health outcomes in people with COVID-19.


Julia Faulconbridge, the British Psychological Society’s Division of Clinical Psychology, said:

“These are interesting findings, however there are questions as to how applicable they are to other contexts. There is limited information on potential causal mechanisms for the correlations that were found. The lack of diversity in the study is an issue, with all the group being American veterans, and the majority being older white men. It is likely this group were already more predisposed to higher levels of mental health difficulties and socioeconomic and relationship difficulties.

“The study is limited to what is in medical records and so does not give any picture of the wider context of the people’s lives and so does not help us to understand the impact of the illness and how changes in their circumstances may have led to the mental health problems. As an example, the interplay between socioeconomic factors and mental health issues as a possible factor is only mentioned in passing as they are mainly considering possible medical causes for the mental health difficulties.  The study states that the relationship between mental health problems and covid may not be unidirectional, as those with mental health problems are more at risk of getting covid.

“We know that those living in poverty, in insecure work and living in poor housing are also more at risk both of getting covid and are more at risk of mental health problems   There is no data on the impact that having covid has had on their lives, for example their ability to work, and the subsequent impact on their mental health. This is particularly important given that estimates of the incidence of Long Covid are in the area of 10% of infections. There will be people who were coping with problems before the illness, who may have been tipped over the edge by the impact of the illness. Finally, they do not differentiate between those who had ICU treatment compared to non ICU. ICU treatment is known to lead to increased mental health problems, regardless of  the reason for being in there.

“In summary, the research findings are interesting, however there needs to be further research and consideration of the wider context of people’s lives – for example, living conditions, employment and relationships – on their likelihood to experience mental health difficulties, as well as possible longer term physiological and neurological changes , in order to understand the mental health impacts of Covid-19 ”


Dr Max Taquet, NIHR Oxford Health BRC Senior Research Fellow, University of Oxford, said:

“This is a well-conducted study which confirms the findings from several previous studies showing that after COVID-19 infection, patients are at an increased risk of developing mental health disorders. While the data is limited to US Veterans, other studies representative of the larger population have found similar findings. The fact that patients appear to still be at an increased risk 12 months after their COVID-19 diagnosis is concerning. But whether this represents delayed diagnoses or new onset of mental illness remains to be determined.”


Prof Paul Harrison, Professor of Psychiatry, University of Oxford, said:

“The study builds on prior work of this kind, which had shown that COVID-19 is followed by an increased risk of common mental disorders, more so in those hospitalized during the acute infection. The main advance of this study is that it extends the follow-up period to twelve months. The study is well conducted and analysed, and the authors acknowledge several limitations. One is that people recovering from COVID-19 might have a lower threshold for presenting for health care, or their doctors might be more likely to make a diagnosis.  Nevertheless, the findings strengthen the case for adequate resourcing of mental health care in COVID-19 survivors, and for research into the causes and treatment of the disorders.”


Dr Nilu Ahmed, Behavioural Psychologist, University of Bristol, said:

“This is timely research that supports data from other regions and cohorts on the escalation and intensification of mental health conditions (including anxiety, depression, and stress) that living through a pandemic has wrought across the general population. This study adds the important finding that people who have had Covid are at further higher risk of these conditions compared to those who have not had Covid.

“The study strengthens the growing evidence base on the need to invest in mental health as part of strategies for social and economic recovery from the pandemic. The burden of mental health disease impacts all sectors of society. We are still learning about the effects of long covid which is resulting in poor mental health as well as physical health, and this study adds to this by highlighting it is not just long covid that increases the risk of mental health issues.

“The key limitation is its cohort – US veterans who are predominantly older white males. This limits the generalisability of the study; we need more research on marginalised groups where indications are there will be higher levels of unmet mental health needs due to the intersecting of systemic racism and access to health care.”



‘Risks of mental health outcomes in people with covid-19: cohort study’ by name of first author et al. was published in The BMJ at 23:30 UK time on Wednesday 26th.

DOI: 10.1136/bmj-2021-068993



Declared interests

Prof Paul Harrison: “No conflicts with the authors or the work.”

None others received.

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